Toga‐Like virus as a cause of fulminant hepatitis attributed to sporadic non‐a, non‐b

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Abstract
Virus‐like particles (60–70 nm) with spiked surfaces budding into cell vacuoles and rod‐shaped inclusions were detected in nuclei of hepatocytes from a British patient transplanted for sporadic non‐A, non‐B fulminant hepatitis (NANBFHF), probably contracted in Kenya. Identical particles were seen in two successive grafts (days 2 and 10) at regrafting for recurrent FHF. Ultrastructural features resembled those of the RNA‐containing arbovirus, Rift Valley fever virus, but serological markers against a representative panel for arboviruses (Togaviruses) and transmission in mice proved negative. The particles shared features with the different arboviruses seen in the hepatectomy specimen of a second patient with NANB‐FHF, and in both patients an insect vector was implicated in the clinical history. The particles were identical in size to those of a third patient with NANB‐FHF, who had remained in the United Kingdom. These findings, together with the recent report of isolation of an RNA‐containing virus resembling the Togaviridae, in parenteral NANB, suggest that several exotic virus‐like agents resembling the arboviruses may be involved in the aetiology of NANB, including in the sporadic forms of FHF in the United Kingdom.